Sizing Up Food Marketing and Childhood Obesity

Washington, DC - December 15, 2009

Thank you for that introduction, Chairman Leibowitz. Jon’s been a great advocate for American consumers for many years, whether it’s helping them get affordable prescription medicines…or protecting their personal information…or fighting predatory loans. I’m so glad to have him as a partner on this important issue.

I’d also like to acknowledge two members of my department whom you’re going to hear from later today: Dr. Barbara Schneeman from the Food and Drug Administration and Dr. Bill Dietz from the Centers for Disease Control and Prevention. Dr. Schneeman and Dr. Dietz are representing our department in the interagency working group on this topic. And they have an exciting update for you later, so be sure to stick around for their session.

Finally, I want to thank all of you for being here today. We’ve got a wide range of folks in the room from scientists to industry leaders to consumer advocates. And that’s encouraging because childhood obesity is an area where we’ve understood the health risks for a while, but we’ve been slow to start acting that way. So we need all the good ideas we can get, and we’re looking forward to working with you as we try to create a healthier future for our children.

What we know is that today, one in three American children is overweight or obese. And being overweight as a kid is associated with a wide range of health problems from high blood pressure to asthma to diabetes to depression.

It’s also associated with being overweight as an adult. Ad that has even bigger health costs. Adult obesity increases your chances of heart disease, stroke, and certain cancers. It’s the single biggest predictor of whether you’ll get diabetes.

Then there’s the cost to our economy. Chronic diseases, many of which are linked to obesity, account for 75 percent of our health care costs. Which explains why the CDC estimates that obesity costs our health care system almost $150 billion per year, nearly twice what it was in 1998.

Just to put that in perspective, the American Cancer Society estimates that every cancer added together costs our health care system just under $100 billion a year. So if you’re talking about reducing health care costs, ending obesity would save you 50 percent more than curing cancer.

That’s the challenge. But there’s one other piece of it, which is: these problems aren’t getting better. The share of kids that are overweight is four times higher than it was 40 years ago. And just to give you one anecdotal example, they used to call Type II Diabetes “adult-onset” diabetes. But now they don’t use the term because so many kids are getting it.

Now imagine if one in three American kids was being subjected to radiation that dramatically increased their risk of getting cancers and other diseases. And imagine if this radiation wasn’t going away. Think about what the reaction would be like. You’d have alarm bells going off all over the country. It would be on the front page of every newspaper. We’d be treating it as a national public health emergency.

That’s the kind of urgency I believe we need to have. The fact that many of the consequences of childhood obesity will come ten, twenty, even sixty years from now doesn’t make them less damaging. Americans are getting sick and paying higher medical bills and in some cases, dying because we didn’t do enough to help them stay healthy when they were young. That’s unacceptable.

I’ve talked with President Obama about this issue, and I know he shares this urgency. So does the First Lady, who’s become America’s leading advocate for prevention and wellness in addition to being the world’s most famous vegetable gardener. And I think this urgency is reflected in the policies his administration has pursued so far.

The most significant of these policies is the $650 million in the Recovery Act for reducing obesity and smoking cessation. This is the single biggest investment in health and wellness we’ve ever made in this country. It’s a sign that this is a major strategic priority for the administration. And it recognizes that there are a range of factors that influence obesity.

From a narrow perspective, it’s easy to explain why our weight goes up or down. It’s the number of calories we consume minus the number of calories we use. But what we’ve learned is that there are dozens of other variables that affect these numbers.

For example, it can depend on whether you get healthy meals at school. It’s whether there are supermarkets that sell fresh produce in your community. It’s whether it’s safe to walk around in your neighborhood. Do you get to run around in gym class or is it one of those classes where everyone stands around waiting to use one piece of equipment?

The answers to these questions matter. It turns out that what we want to eat is only a part of how we decide what to eat. Cost and convenience are just as important. You may not want the chocolate bar, but if you only have a dollar and that’s all they have in the vending machine, you’re going to get a chocolate bar.

So recognizing that all these factors matter, what we’ve done with most of the $650 million is split it up into grants for states and local communities. They’ll be able to use that money to expand strategies like serving fresh produce in schools that are proven to increase healthy eating. We’re reviewing grant applications right now, and we’re already seeing a lot of very promising ideas.

A lot of the factors that affect obesity have to with what kind of foods are available to Americans. But we know there’s another category that influences what we eat, and that’s advertising. Today, I want to talk about two kinds of advertising in particular: ads on TV that are targeted at kids and front-of-packaging labels that are targeted at parents.

Here’s something disturbing, which I read the other week. A market research firm surveyed kids to find their top ten most beloved brands. One was Disney. Another two were video game systems. And the remaining seven were some of the most unhealthy foods on the market from Cheetos to Doritos.

When we hear this list, we think: “Of course: kids love junk food.” But in the context of the huge health consequences of childhood obesity, it’s pretty disturbing. It’s also not a surprise. The companies that make these products are not stupid. The reason they spend $1.6 billion a year – more than the GDP of Belize – marketing food to children is because it works.

The research in this area is pretty clear. Our children spend more than five and a half hours a day using media, and for almost all of those hours, they’re bombarded by ads. If you’ve ever watched morning cartoons, you’ve noticed that a lot of these ads are for food. According to one study, if you’re watching a children’s television network, you’ll see a food ad every 8 minutes.

And these aren’t ads for All Bran or Fiber One. In fact, one group of researchers studied this and they found that, compared to cereals marketed to adults, cereals advertised to kids have 85 percent more sugar, 65 percent less fiber, and 60 percent more sodium. They also looked at the top ten most unhealthy cereals that were advertised and the top ten cereals that were advertised to kids. Eight of the ten were the same.

With new ways to reach kids emerging like websites and games that can be even more effective and harder for parents to monitor, now is the time to act. Our interagency working group has been working hard to develop recommendations for nutritional standards we will use to decide which ads should be shown to kids. Later today, you’ll get to hear about the first draft of those recommendations.

No matter what standards we create, we’re probably not going to stop kids from liking Cheetos. But if a kid gets diabetes when he’s 18 partly because when he was younger, he only ate the foods he saw everyday on TV and the internet, that’s not his fault. It’s our fault. So we need to start doing a better job regulating the type of ads our kids see. That’s what these new standards will do, and we welcome input from all of you as we try to get them right.

You’re going to hear a lot more about this process later today, so before I go, I also want to tell you about another HHS initiative around obesity and marketing. This one has to do with nutrition messages targeted at parents, specifically what’s called front-of-package labeling. You’ve all seen them. They’re the green check marks, number ratings, stars, hearts, and a handful of other icons that you see as you walk up and down the supermarket aisles.

Understandably, these labels are popular. I remember being a working mom, going grocery shopping. We didn’t have the “Nutrition Facts” label on the boxes back then, but even if we had, I wouldn’t have had time to pull out every cereal box and turn it over. Short hands are useful. That’s why Siskel and Ebert gave two thumbs up. It’s why Consumer Reports has Editors’ Picks. We don’t think front-of-package labels should replace nutrition facts, but we do think they’re potentially a useful way for busy shoppers trying to make sure their families eat healthy.

I say “potentially” because these labels are only as helpful as the information they convey. And in that area, their record is mixed. Right now, there are so many of these labels that consumers have a hard time knowing what each one means. What makes it even harder is when different manufacturers used different criteria to decide which products are most nutritious. That’s what happened recently when a new front-of-pack system was designed that endorsed products like Froot Loops and mayonnaise.

Now the label may have been technically accurate, but how low are we setting the bar when we promote products like these as nutritious? So after seeing the gap between the potential of these labels and the reality, we decided to use the FDA’s authority to create some basic, scientifically valid rules that could help make these labels work for consumers.

Our first step was to write a letter to the food industry explaining what we were doing and calling on them to take more responsibility for the nutrition information they were providing consumers. And we got some immediate results. Not only was the Smart Choices program suspended, but just a few days ago, General Mills announced that it was going to reduce the amount of sugar it adds to cereals marketed to kids. These are the same types of positive changes we saw when we introduced the Nutrition Facts label in 1994. And that’s why we believe that credible, standardized, and easy-to-understand labeling can not only help consumers make healthier choices but also put pressure on producers to make healthier products.

We’re also taking three additional steps to make front-of-package labels work better for consumers. First, FDA is in the process of identifying and analyzing front-of-pack labels that appear to be misleading, and considering appropriate enforcement action

Second, we’re working to produce a rule that will create consistent criteria for food labels. Right now, it’s up to the manufacturer to decide what criteria to use to rate the nutritional value of its own foods. Having one set of science-based criteria will help consumers get good information while still allowing manufacturers to highlight their food’s healthy qualities.

Third, we’re conducting consumer research to see what kinds of front-of-pack, voluntary, government-approved symbol system would be most effective for retailers and manufacturers to use. The advantage of this approach is that it could serve as a universal symbol that consumers could count on regardless of which manufacturer or which retailer used it. No companies would be required to use these symbols. But they would give healthy producers an advantage, which might prompt less healthy producers to reduce their sodium and calories, which is exactly the kind of healthy competition we want to create.

We’re currently moving forward in all these areas, and you can look forward to hearing more about the progress we’re making from FDA Commissioner Margaret Hamburg sometime soon.

When we talk about childhood obesity, the challenge can seem overwhelming. It is so widespread. There are so many reinforcing factors. The health risks are so large. The costs to our health care system are so high.

But the flipside of this challenge is the huge opportunity we have if we can reduce childhood obesity. If we can bring childhood obesity down even a little bit, there would be huge benefits for our health care system, for productivity, and for the health of our country. It won’t be easy. But we can start by not overwhelming kids with ads for unhealthy foods and making it easier for parents to find healthy foods. And I’m looking forward to working with all of you to figure out how to best accomplish those goals and keep our kids healthy.